A Conversation with Dr. Frank Veith
Dr. Frank J. Veith is the current president of the American Board of Vascular Surgery and serves on the editorial boards of four vascular surgery journals. Among his many accomplishments, Dr. Veith made pioneering contributions to limb-salvage surgery and the field of endovascular grafting for traumatic, aneurysmal and occlusive arterial disease.
| Learn More
| Which problems do some areas of surgery treat?
Problems with the body’s circulatory system – our veins and arteries
Lung cancer, esophageal cancer, emphysema, mediastinal diseases, mesothelioma, hyperhidrosis
Endocrine and Oncologic Surgery:
Malignant diseases of the breast, gastrointestinal tract, liver, and endocrine organs such as the thyroid and adrenal gland.
Gastrointestinal & Laparoscopic Surgery:
Problems of the esophagus, stomach, gallbladder, pancreas, small bowel, colorectal problems, and hernias
Dr. Veith is a professor of surgery at The Cleveland Clinic Foundation. He graduated from Cornell University Medical School in 1955 and performed his residency at Peter Bent Brigham Hospital, Harvard Medical School. He has authored or co-authored more than 1,000 articles or chapters in prestigious medical journals such as JAMA and The New England Journal of Medicine. Dr. Veith hosts the annual VEITHsymposium, which is acknowledged to be the finest postgraduate course for Vascular Surgery in the world. Frank Veith also manages to find time to be an avid and accomplished wind surfer.
Veins1 caught up with Dr. Veith during the VEITHsymposium, which explores current issues and controversies in the field of vascular disease management. Dr. Veith spoke with Veins1 about vascular surgery; its history in the medical world and how new medical technologies may change the field.
Veins1: How did you get into the field of vascular surgery, and what do you like about it?
Dr. Veith: Vascular surgery has always been a very challenging field. It’s very technically demanding and gratifying. The patients that we deal with are usually pretty sick and there’s quite a bit you can do to help them. There is a circumscribed body of knowledge that one can master, so in all these ways, it’s a great field.
Veins1: What are the biggest challenges?
Dr. Veith: The patients, by the time they need treatment, have life or limb threatening problems. If they’re not treated properly with a lot of skill, they end up with a very bad outcome, whereas if they’re treated well, they end up with a good outcome. So you can really make a difference in their lives and in that sense the field is both challenging and rewarding.
Veins1: Can you tell me a little about the history of the VEITHsymposium?
Dr. Veith: The VEITHsymposium is in its 32nd year. The conference grew out of a very small meeting which was begun by another leading vascular surgeon, Henry Haimovici. It was held in one of the smaller hotels in New York, and attracted 100 or 150 people. I became involved with the meeting in its fifth or sixth year and the conference grew by virtue of the fact that the field of vascular surgery was evolving, and becoming distinct and more separate from other subspecialties in general surgery. And it grew by virtue of the fact that we introduced a lot of innovations – more speakers, more cutting-edge topics. It really became a review of what was new and exciting and different in vascular surgery. It attracted a larger and larger audience.
We also developed relationships with device makers and pharmaceutical companies, that is, the corporations that made devices or produced drugs that were relevant to vascular surgery. Our meeting was really one of the first to recognize the importance of our corporate colleagues. We recognize the importance of their need to interact with the physician community, and we gave them the opportunity to do so. However, it’s really the scientific quality of the meeting that makes it as good as it is. But there’s also an opportunity for corporate-physician interaction in a very positive way, not a commercial way, so that industry can make its accomplishments and new developments known.
The thing that differentiates us from other meetings at present is the newness, the quality, and the brevity of the presentations. It really covers the spectrum of things that are important and new in the vascular world. We were also among the first to recognize the importance of endovascular technologies to vascular surgery. Even going into the late ‘80s, when endovascular technologies were regarded with a certain amount of disdain by most of the thought leaders in vascular surgery, we recognized that this was a foolish attitude. So we constantly, early on, and consistently promoted the importance of endovascular treatments to vascular surgeons. This was also a major positive element in the quality of the meeting and in our growth.
Another thing that we did early on is we recognized the importance of accomplishments of non-U.S vascular surgeons and other specialists who were interested in vascular disease. We were the first to recognize the importance of the multi-disciplinary approach to vascular disease. Whereas many other vascular surgery meetings were dealing more with the past, the traditional approach, we always featured things that were at the cutting edge, new, and early in their development.
Veins1: In your opinion what are some of the most exciting developments in vascular surgery in the last five years?
Dr. Veith: From a general point of view, the growing importance of endovascular treatments across the board. The fact that the trend in all of surgery is to be less invasive, and a wonderful way to do that in vascular disease is to approach blood vessels from within rather than from without. Whether the lesion is an aneurysm, which is a weakened, widened artery, or a narrowing or a blockage, endovascular approaches have generally changed the face of the way we treat vascular pathology.
That’s not to say that open surgical approaches are not still an essential part of what we do. But the idea of using newer imaging techniques for diagnosis, and the idea of treating vascular lesions in a less-invasive endovascular way, has really transformed what vascular surgeons are and what they do.
Veins1: What do you see happening in the next five years? What are some new developments that are really exciting right now?
Dr. Veith: I think the continuing evolution of devices and techniques for treating vascular pathology. There’s a danger in this too, because if these treatments become higher tech, easier, and less morbid for the patient, there’s a temptation to do too much, to use these technologies perhaps where they might not be indicated. That’s always a concern. At our meeting, we’ve tried to evaluate outcomes and try to figure out what should be done and what shouldn’t be done.
One thing which we’ve always been excited about, since we were a pioneer in its use, is the use of EVAR for ruptured aneurysms. When we first presented it we were treated with a lot of doubt and the concept was treated with disdain, but it’s proven now to be useful in at least some circumstances, although the precise circumstances are still controversial.
The use of endovascular grafts for thoracic aneurysms and thoracic pathology is also an exciting new topic, and there are many other spin-offs of those two areas, plus there are a lot of other areas where there are exciting things going on.
The other area where there’s a lot of excitement is in treating carotid bifurcation lesions with stents to prevent strokes. We keep trying to evaluate whether or not it’s the best approach. It’s certainly an exciting new development, and it appears to work. But does it work better than surgery, does it have fewer risks than surgery? It’s clearly less invasive than an open operation. But, for example, we learned just last year that in people over 80 the complication rate appears to be greater, and it’s possible the procedure shouldn’t be used in that subcategory. So we’re trying to sort out when these procedures should be used.
Veins1: It seems like there’s some debate on the effectiveness of EVAR, or endovascular abdominal aortic aneurysm repair.
Dr. Veith: When new things are introduced there’s always a phase of skepticism, and a “this is never going to work” attitude. Then there’s a phase when everyone thinks it’s a panacea, the greatest thing since sliced bread. Then there’s a phase when one recognizes the imperfections of the new technology and the problems. Those phases often go on together.
We’re always looking at upsides and downsides, complications, limitations, trying to be critical in our analysis of the new treatments so they can be used in the appropriate way and the appropriate circumstances.
As the devices got better and the problems were resolved, I think the concept that EVAR is going to be a failure has dwindled away. I think most people now believe that EVAR is here to stay, that it may not be perfect, and that it’s getting better. We’re beginning to understand when and how it should be used and how to use it better. I think the EVAR controversy is less prominent now than it was a couple years ago. On the other hand there may be some over enthusiasm for its use, and that may not be so good either.
Veins1: Can you tell me a little about biodegradable stents?
Dr. Veith: I don’t think the jury has come back yet about what their role will be. They have certain theoretical advantages, they have certain theoretical limitations, and I don’t think their precise role has been properly sorted out yet.
Veins1: What are the theoretical advantages and limitations?
Dr. Veith: When you put a foreign body in an artery or vessel, it elicits a response of some sort which can be negative. If the device is absorbed, as biodegradable stents are, then obviously the stimulus for bad effects goes away as well. That’s the good part of it. The absorption process, however, can elicit a negative response that’s worse than it would be with a standard metal stent. I don’t think we yet know whether the biodegradable stents bring more to the table or less.